title: Clinical predictors of contrast-induced acute kidney injury in patients undergoing emergency versus elective percutaneous coronary intervention.
abstract: BACKGROUND
  To evaluate the incidence and clinical predictors of contrast-induced acute kidney injury (CI-AKI) in patients with ST-segment elevation myocardial infarction (STEMI), unstable angina pectoris/non-STEMI (UAP/NSTEMI), and stable AP (SAP) undergoing percutaneous coronary intervention (PCI).
  
  
  RESULTS
  We enrolled 1,954 patients (SAP, n=1,222; UAP/NSTEMI, n=277; STEMI, n=455) who underwent PCI. Patients were categorized according to contrast media volume/estimated glomerular filtration rate ratio (CV/eGFR low: <2.0, mid: 2.0-2.9, high: ≥3.0). CI-AKI was defined as an increase in serum creatinine of 0.5mg/dl or 25% within 1 week from contrast-medium injection. The incidence of CI-AKI was highest among the STEMI patients (SAP, 4.24%; UAP/NSTEMI, 10.7%; STEMI, 16.1%, P<0.01). Significant predictors of CI-AKI were emergency PCI (odds ratio [OR] 3.70; 95% confidence interval [CI] 2.55-5.37; P<0.001), ejection fraction <40% (OR 2.04; 95% CI 1.24-3.36; P=0.005), and hemoglobin <10g/dl (OR 0.02; 95% CI 1.17-4.55; P=0.02) after multivariate logistic regression analysis. In the SAP group, a CV/eGFR ratio ≥3.0 was a significant predictor of CI-AKI (P=0.048), but not in UAP/NSTEMI and STEMI patients.
  
  
  CONCLUSIONS
  UAP/NSTEMI and STEMI patients undergoing emergency PCI were at high risk for CI-AKI regardless of CV/eGFR ratio. Minimizing the dose of contrast medium based on eGFR might be valuable in reducing the risk of CI-AKI in SAP patients.
authors.affiliation: Department of Cardiology, Ibaraki Prefectural Central Hospital.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Abe
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hoshi
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kakefuda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Watabe
authors.forename: Eiji
authors.initials: E
authors.lastname: Ojima
authors.forename: Daigo
authors.initials: D
authors.lastname: Hiraya
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Harunari
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Takeyasu
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000453:epidemiology / Q000628:therapy; D003287:Contrast Media / Q000009:adverse effects*; D017558:Elective Surgical Procedures; D004632:Emergency Medical Services; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests
chemical_list: D003287:Contrast Media